If not on Medicaid already, a family needs to follow step one even if they or their child have basic medicaid because they still need SSI determination for disability medicaid determination and disability medicaid is a separate process and application from basic medicaid in Colorado.
Prior to beginning the steps below, it is helpful for a family to gather the following documents which will be needed for Step #1 & #2:
Lists of Doctors and Contact information
List of diagnostic codes
Family has to apply with SSI (Social Security Insurance through Social Security Administration) first for the child, to get disability determination.
Yes or No?
No- can appeal that but not able to apply for disability Medicaid until you get yes determination from SSI.
Yes- but resources exceed 2K, don’t get SSI, then continue to apply for disability Medicaid with SSI disability determination so can get Medicaid disability determination
Yes and resources under 2K and or no income, then family can apply for child for Medicaid and disability medicaid (applying for regular basic medicaid is a quick process which will give you medicaid insurance while you go through the longer process for disability medicaid determination and the even longer process of applying for waivers)
Get disability determination and then apply for state Medicaid (Colorado)
Sometimes can take a few months for Medicaid to respond. After their response, you can go forward in waiver process.
Pitfalls- Usually difficult to get appt at Medicaid office, when you get an appointment the family can fill in the basic Medicaid application and fill in paperwork for record release for physicians to release medical records.
Approach the Community Center Board (all disabilities and all waivers) that serves your location and/or Single Entry Point agency (only for medically fragile kids, only service 1-2 waivers) to complete grant and waiver applications.
About waivers and services:
Other Grants may be available for the family.
As a family goes through Community Center Board and needs SSI determination for grants. The FSSP grant (up to $3,400) is available earlier than waivers as Community Centered Boards assess families for this first before waivers. Waiver amounts vary depending on the waiver (the CES waiver is 36,000 but each waiver is different).
Acronyms to understand:
SSI- Social Security Insurance
CCB- Community Center Board, services all disabilities and all waivers
SEP-Single Entry Point, services are focused on more medically fragile children, A Rise Above is an example of a single entry point (SEP):
If you have a child with special health care needs (with or without a genetic diagnosis) and do not qualify for income based Medicaid services in the state of Colorado, for questions about Medicaid Buy-in, Waivers, and Social Security (SSIMed), call Kathy Ciano-McGee at A Rise Above , 719-418-7830 for assistance. A Rise Above is willing to speak with all families no matter what their health, medical, developmental or behavioral concerns for their child, and help families navigate to the best services for their child.